Provider Demographics
NPI:1912610353
Name:INNOVATIVE PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:INNOVATIVE PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTORY
Authorized Official - Prefix:DR
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:UZOAMAKA
Authorized Official - Last Name:EDOKPAYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-492-8519
Mailing Address - Street 1:118 ELDRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4695
Mailing Address - Country:US
Mailing Address - Phone:832-564-3526
Mailing Address - Fax:888-273-0398
Practice Address - Street 1:17070 RED OAK DR STE 309
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2616
Practice Address - Country:US
Practice Address - Phone:281-207-0461
Practice Address - Fax:888-273-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty